PANCREATITIS

inflammation of the pancreas, either acute or chronic. Development of the disorder has been associated with intake of alcohol, trauma, and obstruction of pancreatic ducts. The process of inflammation starts with the escape of activated pancreatic enzymes into the tissues of the pancreas. These digestive juices cause chemical irritation, with edema (collection of fluid) and with congestion of the blood vessels. Often the inflammation then subsides, but occasionally there is bleeding, necrosis of pancreatic tissue, and formation of pus. Infection may set in. With recovery, the necrotic areas are replaced with scar tissue. The onset of pancreatitis may bring severe pain, most acute when the affected person is lying on his back. There may be slight fever, nausea, and vomiting, and the blood pressure may be somewhat higher than usual. If the attack is severe, the skin may be cold and moist, the pulse feeble and rapid, and the temperature below normal. Treatment of acute pancreatitis is directed toward control of pain, prevention or alleviation of shock, inhibition of the secretion of pancreatic juices (including eliminating oral intake of food), and avoidance of infection. Lost fluids and salts are replaced. In chronic pancreatitis, with its repeated attacks, much of the pancreas may be destroyed, with resultant deficiency in the amounts of pancreatic juices secreted. Islet cells of the pancreas may also be destroyed, so that the secretion of insulin is depleted and diabetes mellitus develops. Management of this disorder includes a low-fat diet, abstinence from overeating and from intake of alcohol, the administration of pancreatic extracts, and control of diabetes, if it has developed.